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Diverticulitis symptoms, causes, treatment – Diverticulitis

Diverticulitis is a condition in which diverticula in the colon get inflamed. In the following article, you will learn all you need about it.

Diverticulitis is the most frequently listed gastrointestinal diagnosis in outpatient clinics. The chance of getting diverticulitis increases with age. It goes from 20% of probabilities at age 40 to 60% by the age of 60 years old. Also, diverticulitis is the leading indication for elective colon surgery. Additionally, the number of diverticulitis cases have increased in the past years. Doctors think this is related to changes in the diet over the past decades.

In the following article, you will find the answer to the most frequently asked questions about this condition. Everything you need to know, from what causes it, to its symptoms and its treatment, directly from a doctor. Don’t worry; everything is briefly explained and, simply put, so you end up with integral knowledge about this disease.

What is this disease?

Diverticulitis is one of the forms of diverticular disease. In this condition, your colon (large bowel) has diverticula in its wall. Diverticula are small pouches or pockets in the colon wall. They arise from the colon’s inner layers, and they push through the weakness in the outer muscular layers. The appearance of diverticula is acknowledged as diverticulosis. 

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Sigmoid diverticulum
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When these diverticula get inflamed, you have diverticulitis. Diverticular disease is a name that incorporates both diverticulosis and diverticulitis. Diverticula can appear anywhere in your digestive tract, but they are most common in the colon. This is known as colonic diverticulitis. Also, colonic diverticulitis mostly affects the descending colon and the sigmoid colon (the left part of your colon).

File:Blausen 0604 LargeIntestine2.png
Large Intestine
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Diverticular disease can be both asymptomatic (without symptoms) or have acute and chronic symptoms. The asymptomatic form is diverticulosis, while diverticulitis can be acute or chronic. 

Doctors don’t know what exactly causes diverticular disease. However, a low fiber diet and constipation are important risk factors for both diverticulitis and diverticulosis. 

What causes diverticula, and how do diverticula form?

Diverticula are protrusions of the mucosa that appear through weaknesses of the intestinal wall. This happens because the large intestine has only one muscular layer. On the other side, the stomach and the small intestine have two muscular layers, making them more resistant. The colonic wall has blood vessels that nurture it, and these vessels penetrate through the muscular layer. Diverticula usually appear in sites where these blood vessels penetrate the muscular layer.

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Colon diverticulum
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The larger the vessels, the larger the area of weakness in the muscular layer. When partially digested food goes into your colon, it will start moving to push the food through the colon tract. This causes an increase in intestinal pressure. This process occurs naturally and is part of the digestion of food. However, if the intestinal pressure is really high, it can lead to atrophy and herniation of the colonic wall. This is one of the reasons that diverticula are more common in the sigmoid colon.

The sigmoid has a smaller caliber and receives a higher intestinal pressure than other parts of the colon. Also, as patients age, the colonic wall’s elasticity decreases, making it more prone to tears and diverticula. 

File:Intraoperative view of sigmoid diverticulitis.jpg
Intraoperative view of sigmoid diverticulitis
Source

What is the difference between diverticulitis and diverticulosis?

The main difference between diverticulitis and diverticulosis is inflammation. In diverticulosis, the patient has diverticula in their colon; however, they are not inflamed or infected. Also, most of the time, patients with diverticulosis don’t experience any symptoms. In fact, diverticulosis may remain untreated.

On the other side, diverticulitis occurs when these diverticula get inflamed or infected. Unlike diverticulosis, diverticulitis causes many symptoms, and it may result in a complicated condition. Also, diverticulitis needs to be treated by a doctor since it can lead to unwanted complications. 

Who is more likely to have diverticulosis and diverticulitis? 

Like any other condition, the diverticular disease has risk factors that make you more prone to develop it: 

  • Age: People older than 40 years old: As people grow older, the colon’s elasticity decreases, causing diverticula to form. 
  • Overweight and obesity.
  • Diet: A diet with low fiber and high fat and red meat is the perfect recipe for constipation. 
  • Medications: Especially non-steroid anti-inflammatory drugs like aspirin and ibuprofen. 
  • Smoking: It lowers the blood flow towards your organs and makes your colon more prone to diverticulosis and diverticulitis. 

What are the symptoms of diverticulitis? 

The symptoms of diverticulitis can vary depending on many factors. The diverticulum location, the severity of the inflammation, and the presence of complications can change the symptoms.

The most common symptoms of diverticulitis include:

  • Abdominal pain: Most commonly in the left lower quadrant of the abdomen. This also depends on the location of the diverticula. 
  • Nausea and vomiting.
  • Constipation: Remember that constipation is also a risk factor for developing diverticulitis, so they are closely related. 
  • Fever: In the event of infection, you can present a mild fever or chills. 
  • Flatulence and bloating. 
  • Rectal bleeding

During the physical examination, your doctor can find: 

  • Abdominal tenderness: It is located where the inflamed diverticula are. 
  • Abdominal distention.
  • Tender mass: Usually related to the presence of an abscess or pus collection. 
  • Absent bowel sounds: Indicates perforation of the bowel. 

As you can see, these symptoms are very unspecific and can be mistaken for other conditions.  

You must remember that diverticulosis doesn’t cause any symptoms. However, any diverticulum can get infected or inflamed at any time. This means that if you have diverticulosis, you are likely to developing diverticulitis easily. So, if you start experiencing any of the symptoms we’ve mentioned, you should go to a doctor. 

What conditions can be mistaken for it? 

Since the symptoms of diverticulitis are unspecific, it can mimic many conditions, such as:

  • Acute appendicitis: Diverticulitis in the right colon can cause symptoms similar to appendicitis. 
  • Colon cancer or colorectal cancer: Especially for symptoms like bleeding and changes in the bowel habit. 
  • Pancreatitis, cholecystitis, and peptic ulcer disease: If diverticula are located in the transverse colon can cause abdominal pain similar to these conditions. 
  • Irritable bowel syndrome: Because it causes symptoms like constipation and abdominal cramps. 
  • Gynecologic diseases: In women, pain in the lower quadrants of the abdomen is usually associated with gynecologic conditions. So, it is not easily distinguishable from diverticulitis.

Does diverticulitis affect bowel movements?

Yes. In fact, diverticulitis can lead to bowel obstruction. When diverticulitis occurs, the pockets formed in the wall of your colon get inflamed. This can lead to a smaller caliber that your feces pass through, making it harder for them to move forward. This is why constipation and diverticulitis are so intimately related.

In fact, it is a vicious cycle because constipation acts both as a cause and a consequence of diverticulitis. With harder feces, your colon has to put more pressure on them to move and evacuate them. The higher the pressure, the more likely is your colon to herniate. 

What are the different types of diverticulitis? 

Diverticulitis refers to the inflammation of the diverticula within the large bowel. This disease has four types or classifications that can go together depending on the patient. Diverticulitis can be Acute, Chronic, Complicated, and/or Uncomplicated. There will be a brief explanation of each one of them.

Acute Diverticulitis

Diverticulosis is the presence of a sac-like protrusion on the colon wall. It is present in approximately over 60% of people over 60 years old. Now, acute diverticulitis is the inflammation of these sacs. It is the result of microscopic and macroscopic perforations of the diverticular wall. It occurs in over 5% of the patients with diverticulosis.

Chronic Diverticulitis

Chronic Diverticulitis or Recurrent diverticulitis is a condition that can occur after the nonsurgical management of an acute attack. Nonetheless, it can also happen in patients after resection for sigmoid diverticulitis. Approximately 20% to 35% of the patients that suffer from an acute diverticulitis attack tend to suffer from recurrent diverticulitis.

Uncomplicated Diverticulitis

It refers to the diverticular disease that has an absence of complications. The most common complications for diverticular disease are perforations, fistulas, obstructions, and/or bleeding. It is only the inflammation of the diverticular wall.

The perforation occurs due to an increase in the pressure within the bowel. Food particles will increase the pressure and will erode the diverticular wall causing inflammation and necrosis (death) of the wall, leading to perforation.

Complicated Diverticulitis

Complicated diverticulitis is the inflammation of diverticula with the association of complications. It remains a significant cause of disease and mortality in patients who suffer from diverticulitis. Among the complications of this condition are the following, which will discuss later on: 

How common are diverticulosis and diverticulitis? 

Although both of them are different diseases, diverticulitis cannot exist without diverticulosis. The appearance of diverticulosis increases with age. Diverticulosis affects approximately 20% of the people with 40 years old and 60% of the people over 60 years old.

In the past, the data showed that about 15% to 20% of the patients with diverticulosis would develop diverticulitis. Now, in more recent studies, the numbers are closer to 1% to 4%. On the other hand, around 20% of the patients that develop an acute attack will have one or more recurrent episodes within a lapse of 10 years. Acute diverticulitis accounts for the third most common inpatient gastrointestinal diagnosis.

What are the potential complications of diverticulitis?

Diverticulitis may lead to many complications. Patients with an impaired immune system are more likely to develop these complications. Some of the complications of diverticulitis include:

  • Abscess: a collection of pus may form in a diverticulum due to infection. This is an abscess. Sometimes abscesses may need drainage to be treated.
  • Intestinal perforation or obstruction: Once a diverticulum is infected, it can become perforated. Perforated diverticulitis is the most common complication of the disease. This causes the infection to get to the abdominal cavity and causes peritonitis. Also, feces can get stuck in the diverticula and cause bowel obstruction. 
  • Peritonitis: It is an infection in the abdominal cavity. Normally, this is a sterile cavity, meaning it doesn’t have any bacteria living there. When a diverticulum gets perforated, the bacteria inside of the colon migrate to the abdominal cavity. This instantly causes peritonitis and, if not treated, it can be fatal. 
  • Sepsis: without treatment, diverticulitis can lead to a generalized infection. This is what doctors call sepsis. A patient with sepsis needs to get intravenous antibiotics right away. If not, it can lead to death pretty quickly. 

What tests and imaging procedures diagnose diverticulitis and diverticulosis? 

If you think you have acute diverticulitis, you should go to the doctor. Once there, the doctor will ask questions about your medical history, like your bowel habit and diet. Then, they will perform a physical examination of the abdomen. At this point, they will palpate your abdomen, looking for signs like localized abdominal tenderness, masses, and abdominal swelling. 

The diagnosis of diverticulosis and diverticulitis can be made with just the medical history and physical examination. However, your doctor may indicate some laboratory tests and imaging studies to rule out other conditions first. You should know that there is no laboratory test that diagnosis diverticular disease. Complete blood count, blood chemistries, and other lab tests are useful to exclude other conditions that cause symptoms similar to diverticulitis.

Regarding imaging studies, a CT scan is the best method to confirm the diagnosis. It is the first choice over studies that use contrast like barium enema during episodes of acute abdominal pain. Also, CT scans can help doctors to determine the severity, the clinical stage, and the presence of diverticulitis complications. 

What medications treat diverticulitis and diverticulosis? 

The treatment of diverticulosis and diverticulitis depends on the presence of complications of the disease. Patients with acute uncomplicated diverticulitis usually get better with the treatment of oral antibiotics. Also, patients with mild diverticulitis will likely get outpatient management with a liquid diet and antibiotics. Usually, the antibiotic treatment lasts for 7 to 10 days and includes antibiotics like ciprofloxacin and metronidazole.

In the event of complicated diverticulitis, the patient will require hospitalization for treatment. During hospitalization, a patient with complicated diverticulitis will likely get bowel rest (no eating) and IV fluid hydration (fluid through the vein).

The bowel rest means that you don’t eat any food to allow your colon to heal while getting treatment at the hospital. Your doctor will probably indicate a combination of antibiotics and pain medications like morphine. In the case of diverticulitis, non-steroidal anti-inflammatory drugs (like ibuprofen) increase the risk of perforation. This is why this type of drug is not a recommendation for patients with diverticulitis. 

What is the surgical treatment of diverticulitis? 

Around 15-25% of patients with acute diverticulitis have complicated diverticulitis and require emergency surgery for treatment. On the other side, elective surgery is recommended for patients with recurrent diverticulitis (two or more diverticulitis episodes).

The surgical treatment of diverticulitis usually includes bowel resection of the ill intestine. Depending on the extent and severity of the disease, the surgical procedure can be different.

Some patients may need to get a colostomy. This is a procedure in which surgeons remove the diseased portion of the intestine. Then, they attach the healthy end to the skin with a bag that collects the colon waste (poop). This allows the colon to heal and then attach it again to the rest of your colon. However, not all patients need a colostomy.

Moreover, the resection of the colon can take place in one, two, or three surgeries. Some patients may get minimally invasive surgery through laparoscopic surgery. In this case, incisions are tiny, and the procedure is with a camera and tiny surgical tools. 

Do you have symptoms of this condition?

This tool is a Diverticulitis Symptoms Checker. It gathers the most important signs, symptoms, and risk factors for the disease. Therefore, the tool will tell anybody who uses it the likelihood of their symptoms because of diverticulitis. Using the tool is free and would only take a few minutes.

What do you think?

Written by Dr. Esteban Kosak

Doctor of Medicine - MD Recently Graduated from Medical School and inspired to aid the global population during this situation. I think that we shall no longer be waiting to see a doctor when we feel sick. Several times we feel disease searches in Google drive us to a rabbit hole and come out thinking that we may die of cancer or something very serious, given that symptoms may seem to fit a wide variety of illnesses. Since I recently graduated from medical school. I have all the medical information fresh in my mind. My thorough experience as an expert researcher allows me to very-well known the different diseases and conditions that affect human bodies. Empowered by the United Nations 17 Sustainable Development Goals (SGDs). I think that we all can provide a grain of sand to help humanity. That's why we created Symptoms.Care a place where you can come and screen your symptoms and find what different illnesses can be related to them. Armed with the right information you can instantly, discretely, secure and from the comfort of your home talk with a Doctor that can Evaluate your Symptoms and help you seek the right treatment.

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